THE PLEA AGAINST ANNUAL INFLUENZA VACCINATION - THE HOSKINS PARADOX REVISITED

Three papers by Hoskins and collaborators published in The Lancet in t he 70s, have been challenging the common policy to annually vaccinate people at risk with inactivated influenza virus vaccine. From an analy sis of a vaccination campaign in adolescent pupils of a boarding schoo l and four influenza outbreaks in the period 1970-76, Hoskins et al. c oncluded that annually repeated vaccinations would not confer protecti on against epidemic influenza in the long-term ('Hoskins' Paradox'). A review of the papers revealed however; that most of the study subject s were not consequently vaccinated every year and that most of the pre sented data were, therefore, not relevant for the problem of annually repeated influenza vaccination When applying strict definitions of sin gle vaccination (immunised immediately prior to the epidemic, but not in the years before) and multiple vaccination (immunised immediately p rior to the epidemic, and also in the year(s) before), only two of fou r epidemics (A/England/42/72 (H3N2) in 1972/73 and A/Port Chalmers/1/7 3 (H3N2) in 1973/74) could be evaluated: in one case, no negative effe ct of repeated vaccination could be detected in the second case the at tack rate difference between groups with single and multiple vaccinati on was of borderline significance. Data on two other epidemics (B/Hong Kong/8/73 in 1973/74 and A/Victoria/3/75 (H3N2) in 1975/76) could not be interpreted because of incomplete vaccination strategies. In concl usion, Hoskins' Paradox cannot be substantiated by Hoskins' own data. Considering other published data on the subject, it is suggested that no negative effect of annually repeated vaccination on protection agai nst epidemic influenza exists. (C) 1998 Elsevier Science Ltd. All righ ts reserved.